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WAL-MART PHARMACY 10-5315
CHC33651-01 TULIP TREE HEALTH SERVICES OF GIBSON COUNTY, INC.
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Covered Entity Details
Entity Name
TULIP TREE HEALTH SERVICES OF GIBSON COUNTY, INC.
Subdivision Name
Tulip Tree Family Health Care Princeton
Type
HRSA-Funded Health Center
340B ID
CHC33651-01
Entity Address
108 N Main St
Princeton, IN 47670-1540
Grant Number
H80CS33651
Participating Start Date
10/1/2022
Last Recertification Date
2/27/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/17/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Kristine Georges, Executive Director
(812) 753-1039
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
10/13/2022
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